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Show ‘33 nxrrnrurron or run BREAsr. or CUTTING our THE GLANDS or THE AXILLA. gland downwards, we tie such arteries as seem to throw out their blood with force. But if the assistant he dexterous whilst he holds aside the integuments, he grasps these lesser arteries also, or puts his finger upon them, so as to allow the opera tion to proceed, and the tumour to be taken entirely away, '1 he assistant then presses a. large soft. sponge upon the wound, until the surgeon has dried his fingers, and be prepared to take up the bleeding vessels. If there be disease in the axilla, it will, perhaps, be better to dissect the tumour upwards, tying those vessels with the te= naeuluni which come from the internal mammary artery, the assistant corn pressing the others, until the whole mass of disease hangs by the upper corner of the wound. Now, we may :- E‘xJLHr-A‘JK‘. --\-‘ either cut it away here, and have the parts free to take up the 135:} satisfied if they are discernible in the tumour, that they are not out, so that part of them is left. If we find that the tumour adheres to the pectoral muscle, the fibres of the muscle must be cut, and part taken with the tumour. This is an unpleasant occurrence, as it implies the advanced progress of the disease. There is no operation in surgery, says Mr. Home, in which secondary bleedings so frequently occur, as in the extirpation of the breast. This often occurs from our leaving the vessels bleeding until the operation be entirely finished ; or from the practice 1 have recommended, that the assistant should place his finger on the orifice, and allow the surgeon to proceed in his operation -, for this makes the arteries to bury themselves in the cellular membrane, though large enough to bleed when arteries, if the blood is flowing over the side of the wound profusely ; or, continuing the incision upwards, we take away the glands in the axilla, the absorbents with their condensed cellular membrane, and the tumour of the breast, in one strinn" of masses. a In taking the (li: - a parts thus united, there is, however, no advantage ; but 1 like to see taken away the cellular meniln'ane in the tract from the breast to the diseased glands, the woman has recovered from her dread, and is laid warm in bed. But there is no alternative, for if we allow these vessels to bleed and exhaust themselves, as I see recommended during. the operation, (besides occasioning hurry during the Around the absorbents, l have often seen a degree of hardness geon sl uld stop, and all three should be taken up. The surgeon ought to be able to say when an artery throws out its in the surrounding membrane ; and, therefore, I conceive it better, if it be a bad case, to continue the upper part of the meizion into the axilla, M hen the breast is tat . out, we must carefully feel the sur» rounding cellnLr nun; . e, that no hardness or little tuber" 1v, ‘ if; ant11:6 r‘ :111:;:1: 1:35: ‘ surgeon, also, should convince h u. , operation} it produces such a loss of blood and fainlness, that many iszl stop and lie concealed, that "will certainly bleed after the operation. When the assistant, therefore, has got. his finger on one or two arteries, and a third springs, the sur- blood, whzther it will require the ligature or not ; and, if it does, it is better to take it up during the operation ; by nhich means every thing is done deliberately, and the patient‘s strength is saved. OF THE CUTTING OUT OF THE GLANDS OF THE AXILLA. \l'emus.t 511-0 'q examin n m l "r e \u ~ '" ted tumour, and 508 in! , erurpa , .9 ,w. N ....., ‘W.-» that there are no surlaccs indicating a diseased Pal-t cut . must be left behmdi a) ' ,1 of much, throueh \ d If ; .ran o' par, of course, ' ' ~‘w' I ‘w H." ' " 5‘ 'llO‘i ' "‘ .' ll "no that Ill», tilting "1.th bands intersecting the tu' mour, form a peculiar character of carcinomar, we must be a ,, 1‘6 ‘~'-'t u, T ‘ bL" , . ‘ w . ., . v . . WHEN the glands of the axilla are much enlarged and deep, it is a much more difficult and dangerous operation to take them out, than the excision of the breast. I have seen a surgeon cut amongst the glands, and then find himself ditliculted in conceiving how they had escaped him , ccourtt 01nd" "PW-"131A": 05' the Crlnrz'cmcr as s- on on (have, , ' .r Home's book. in, 1m or to distinguish which were the glands that he had intended |
